1. List early signs and symptoms of congestive heart failure.

 Difficulty of Breathing – Dyspnea, Orthopnea, Nocturnal Dyspnea.

 Hemoptysis – vomiting of blood
 Syncope with exertion – loss of consciousness
 Chestpain
 Cyanosis
 Clubbing of Fingers
 Neck Vein Distention
 Systoic & Diastolic Murmurs

2. Jean is a 27-year-old woman who is 30 weeks pregnant with her first baby. She
has rheumatic heart disease. She had to stop working at her desk job at 20 weeks of
pregnancy because of persistent fatigue. She has n problems when sitting quietly, but tasks
such as making her bed or gathering laundry to wash cause her to have slight chest pain
and a rapid heartbeat. She complains that she always feels tired. What class of heart
disease do her symptoms suggest? Why?
She is considered to be under the classification of CLASS III:
Based on this Classification:
 CLASS I :
- uncompromised.
- women have no limitation of physical activity
- ordinary physical activity (bathing, ambulation, toileting, transferring, eating, dressing)
causes no discomfort.
- they have no / mild symptoms of cardiac insufficiency and no angina pain.
 CLASS II :
- slightly compromised.
- woman has slight limitation of activity.
- ordinary physical activity causes excessive fatigue, palpitation and dyspnea or angina pain.
 CLASS III :
- markedly compromised.
-women have moderate to marked limitation of physical activity.
- during less than ordinary activity, they experience excessive fatigue, palpitations, dyspnea
or angina pain.
 CLASS IV :
- severely compromised.
- woman have moderate to marked limitation of physical activity.
 - during less than ordinary activity they experience excessive fatigue, palpitations, dyspnea
or angina pain.
- even at rest they experience symptoms of cardiac insufficiency or anginal pain.

3. What anti-coagulant is recommended during pregnancy, if needed? Why?

For pregnant women and women who have given birth, heparin is the anticoagulant
of choice and is recommended by the Royal College of Obstetricians and Gynaecologists. It does
not cross the placenta, and therefore is considered to be safe.